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Prognostic factors in epithelial ovarian carcinoma (ECO) Stage I: A large two-center study
SOCIETY OF GYNECOLOGIC
ONCOLOGISTS-ABSTRACTS
97
chemotherapy. A theoretic, but as yet unproven, benefit from this surgery is the resection of large, presumably radioresistant, pelvic nodal metastasesprior to radiation therapy. One hundred fifty-six patients having undergone surgical staging with excision of pelvic lymph nodes were divided by pelvic nodal status: Group A, negative (81); Group B, microscopic metastases only (18); Group C, macroscopic nodal metastases resected (48); and Group D, unresectable nodal metastases (9). The 5-year recurrence-free survival in Group C (51%) approached that of Group B (57%) and was significantly better than that of Group D (0%). The groups are compared by FIG0 Stage, grade, histology, and incidence of para-aortic metastases. Patterns of recurrence imply improved pelvic control in patients undergoing resection of pelvic nodal metastases. Surgical removal of pelvic nodal metastasesprior to radiation therapy is recommended.
gynecological examination under general anasthesia, endocervical/cavitary curettage, iv pyelography, sigmoidoscopy, and cystoscopy. Three 21-day cycles of PBM were administered according to the following schedule: P(100 mg/m* Day l), B(15 mg Days 1, S), M+c.f.r. (300 mg/m* Day 8). Clinical response was detected in 44 pts (5 CRs, 39 PRs) all submitted to radical hysterectomy (Piver’s type III: 25, type IV: 19) plus systematic paraaortic and pelvic lymphadenectomy (median No. nodes removed: 58, range 37-128). The 14 nonresponding pts underwent radiotherapy. Pathological evaluation showed 4 CRs (6.9%), 31 PRs (53.4%) and 9 NCs (15.5%); 10 pts (22.7%) had positive nodes. NACT-induced toxicity was limited and NACT did not seem to complicate surgery even though the incidence of postoperative complications was remarkable (50%). To date 6/44 (13.6%) operated pts have relapsed (median follow-up 18 months, range 4 + -29 + ).
10. Prognostic
12. Human Papillomavirus
Factors in Epithelial Ovarian Carcinoma (ECOJ Stage I: A Large Two-Center Study. A. DEMBO,R. BUSH, M. DAVY, E.
BERLE,ANDK. KJORSTAD,Princess Margaret Hospital, Toronto (T) and Norwegian Radium Hospital, Oslo (0). In order to evaluate the significance of prognostic factors in Stage I ECO, including those used for FIG0 substages, the records of 252 Stage I “T” (1971-1982)and 387 “0” patients (1977-1983)were reviewed with respect to: age (5 50 years >), uni/bilaterality (Stages IA/IB), rupture, capsule penetration, tumor size (5 10 cm >), ascites, adherence, differentiation, and treatment. There were 133 borderline cases in the 0 series (excluded from further analysis), 3 of whom relapsed. Both on univariate and multivariate analysis, differentiation (P < 0.001) and dense adherence (P < 0.05) were significant predictors of relapse in each series. A similar outcome was observed for densely adherent Stage I tumors and Stage II with no macroscopic residuum (P > 0.8). Approximately 8% of patients presented with large volume ascites, which predicted worse outcome in the 0 but not in the T series, but data on cytology were not available. No other factor was prognostic in either series. The proportion of relapses for both series is shown: Adhesions O/minor: Dense:
Ascites
Grade 1
O/small: i large: any :
4/181 (0.02) 217 (0.29) 5/17 (0.29)
Grade 2
Grade 3
19/118 (0.16) 35/96 (0.36) 4/18 (0.22) 4/7 (0.57) lo/30 (0.33) S/13 (0.62)
There was striking concordance between these two large series, which validates the following conclusions: (1) in Stage I, grade is the most important predictor of relapse: (2) dense adherence warrants inclusion in Stage II; (3) rupture, capsular penetration and small volume ascites do not adversely affect prognosis and do not per se merit treatment or identification by separate substage categories; and (4) the prognostic relationship between cytology positivity and volume of ascites requires further study. 11. Cisplatin (P), Bleomycin (B), and Methotrexate (M) Neoadjuvant Chemotherapy (NACT) in Locally Advanced Cervical Carcinoma (CCA). S. MANCUSO,P. BENEDETTIPANICI, S. GREGGI,AND G.
SCAMBIA,Department of Gynecology and Obstetrics, Catholic University, Rome, Italy. Survival of patients (pts) with locally advanced CCA is poor despite aggressive radiosurgical treatment. NACT has been reported to be beneficial in inoperable solid tumors and CCA to be responsive to Pcontaining regimens. Fifty-eight pts with primary CCA (FIG0 Stage IB-IIA:7; IIB:26; 111:25;tumor volume > 4 cm; median age 56, range 34-69) were evaluable out of the 62 entered in an open nonrandomized study from January 1986 to March 1988. Pretreatment evaluation consisted of chest X ray, bone scan, abdominopelvic USS, colposcopy,
(HPV) DNA in CO,-Laser-Generated Plume of Smoke and Its’ Consequences to the Surgeon. A. FERENCZY,
C. BERGERON, ANDR. RICHART,The Sir Mortimer B. Davis Jewish General Hospital Montreal, Quebec, Canada, and Columbia Presbyterian Medical Center, New York, New York, 10032. CO, laser energy is absorbed by intracellular water but not by proteins or nucleic acids. The possibility of dispersing viral DNA during laser therapy of HPV-containing genital infections has been explored using the dot blot hybridization technique (Virapap/Viratype, LTI, Gaithersburg, MD). Samples were taken using dacron swabs from 1IO patients in nine separate treatment sessions as well as from five filters, four fume evacuator tubes (Biovac), and the nasopharynx, eyelids, and ears of the laser surgeon before and after laser surgery. The viral RNA probes were specific for groups of HPV types 6/l 1, 16/18, and 31/33/35. HPV DNA was identified in swabs fom 65/l 10 (60%) of lesional tissues. One of the five filters tested in 37 (2.7%) HPV DNA positive lesions contained HPV DNA type 6. The four fume evacuator tubes tested from 28 HPV DNA positive lesions were HPV DNA negative as were the nasopharynx, eyelids, and ears of the operator. Although HPV DNA may be released during laser therapy for genital HPV infections, providing appropriate equipment for evacuating HPV DNA positive smoke is used, contamination of the operator is unlikely. 13. Cisplatin and Adriamycin Combination Chemotherapy for Uterine Stromal Sarcoma and Mixed Mesodermal Tumors. W. A. PETERS
III, S. E. RIVKIN, M. R. SMITH, AND D. W. TESH, Puget Sound Oncology Consortium, Seattle, Washington 98104. Twenty-six patients with a uterine stromal sarcoma or mixed mesodermal tumor were treated with cisplatin 100mg/m’ and Adriamycin 45-60 mg/m*, given iv every 3 to 4 weeks with iv hydration. Group I consists of 10 patients with measurable disease following initial surgery or with a recurrence. Seven of the 10 patients with measurable disease had a complete response (70%) and 2 of these patients have had a negative second-look procedure and are alive and disease-free more than 24 months after initiation of treatment. Group II consists of 16 patients treated with adjuvant chemotherapy after primary surgery. The patients were selected for adjuvant therapy based upon previously established poor prognostic features. Of the 16 patients in Group II, 13 had invasion of the outer one-third of the myometrium and the other 3 had invasion to the middle one-third. Seven had documented positive pelvic and/or periaortic lymph nodes and 4 had positive peritoneal washings. With a median follow-up of 30 months, there have been only 4 recurrences in Group II. Two of the recurrences occurred in patients who discontinued therapy after only two cycles of chemotherapy. There is a projected 5-year survival of 72% in these high-risk patients. Of the 7 patients with documented nodal involvement, 1 patient died with a recurrence at 23 months and the other 6 are alive and disease-free
ONCOLOGISTS-ABSTRACTS
97
chemotherapy. A theoretic, but as yet unproven, benefit from this surgery is the resection of large, presumably radioresistant, pelvic nodal metastasesprior to radiation therapy. One hundred fifty-six patients having undergone surgical staging with excision of pelvic lymph nodes were divided by pelvic nodal status: Group A, negative (81); Group B, microscopic metastases only (18); Group C, macroscopic nodal metastases resected (48); and Group D, unresectable nodal metastases (9). The 5-year recurrence-free survival in Group C (51%) approached that of Group B (57%) and was significantly better than that of Group D (0%). The groups are compared by FIG0 Stage, grade, histology, and incidence of para-aortic metastases. Patterns of recurrence imply improved pelvic control in patients undergoing resection of pelvic nodal metastases. Surgical removal of pelvic nodal metastasesprior to radiation therapy is recommended.
gynecological examination under general anasthesia, endocervical/cavitary curettage, iv pyelography, sigmoidoscopy, and cystoscopy. Three 21-day cycles of PBM were administered according to the following schedule: P(100 mg/m* Day l), B(15 mg Days 1, S), M+c.f.r. (300 mg/m* Day 8). Clinical response was detected in 44 pts (5 CRs, 39 PRs) all submitted to radical hysterectomy (Piver’s type III: 25, type IV: 19) plus systematic paraaortic and pelvic lymphadenectomy (median No. nodes removed: 58, range 37-128). The 14 nonresponding pts underwent radiotherapy. Pathological evaluation showed 4 CRs (6.9%), 31 PRs (53.4%) and 9 NCs (15.5%); 10 pts (22.7%) had positive nodes. NACT-induced toxicity was limited and NACT did not seem to complicate surgery even though the incidence of postoperative complications was remarkable (50%). To date 6/44 (13.6%) operated pts have relapsed (median follow-up 18 months, range 4 + -29 + ).
10. Prognostic
12. Human Papillomavirus
Factors in Epithelial Ovarian Carcinoma (ECOJ Stage I: A Large Two-Center Study. A. DEMBO,R. BUSH, M. DAVY, E.
BERLE,ANDK. KJORSTAD,Princess Margaret Hospital, Toronto (T) and Norwegian Radium Hospital, Oslo (0). In order to evaluate the significance of prognostic factors in Stage I ECO, including those used for FIG0 substages, the records of 252 Stage I “T” (1971-1982)and 387 “0” patients (1977-1983)were reviewed with respect to: age (5 50 years >), uni/bilaterality (Stages IA/IB), rupture, capsule penetration, tumor size (5 10 cm >), ascites, adherence, differentiation, and treatment. There were 133 borderline cases in the 0 series (excluded from further analysis), 3 of whom relapsed. Both on univariate and multivariate analysis, differentiation (P < 0.001) and dense adherence (P < 0.05) were significant predictors of relapse in each series. A similar outcome was observed for densely adherent Stage I tumors and Stage II with no macroscopic residuum (P > 0.8). Approximately 8% of patients presented with large volume ascites, which predicted worse outcome in the 0 but not in the T series, but data on cytology were not available. No other factor was prognostic in either series. The proportion of relapses for both series is shown: Adhesions O/minor: Dense:
Ascites
Grade 1
O/small: i large: any :
4/181 (0.02) 217 (0.29) 5/17 (0.29)
Grade 2
Grade 3
19/118 (0.16) 35/96 (0.36) 4/18 (0.22) 4/7 (0.57) lo/30 (0.33) S/13 (0.62)
There was striking concordance between these two large series, which validates the following conclusions: (1) in Stage I, grade is the most important predictor of relapse: (2) dense adherence warrants inclusion in Stage II; (3) rupture, capsular penetration and small volume ascites do not adversely affect prognosis and do not per se merit treatment or identification by separate substage categories; and (4) the prognostic relationship between cytology positivity and volume of ascites requires further study. 11. Cisplatin (P), Bleomycin (B), and Methotrexate (M) Neoadjuvant Chemotherapy (NACT) in Locally Advanced Cervical Carcinoma (CCA). S. MANCUSO,P. BENEDETTIPANICI, S. GREGGI,AND G.
SCAMBIA,Department of Gynecology and Obstetrics, Catholic University, Rome, Italy. Survival of patients (pts) with locally advanced CCA is poor despite aggressive radiosurgical treatment. NACT has been reported to be beneficial in inoperable solid tumors and CCA to be responsive to Pcontaining regimens. Fifty-eight pts with primary CCA (FIG0 Stage IB-IIA:7; IIB:26; 111:25;tumor volume > 4 cm; median age 56, range 34-69) were evaluable out of the 62 entered in an open nonrandomized study from January 1986 to March 1988. Pretreatment evaluation consisted of chest X ray, bone scan, abdominopelvic USS, colposcopy,
(HPV) DNA in CO,-Laser-Generated Plume of Smoke and Its’ Consequences to the Surgeon. A. FERENCZY,
C. BERGERON, ANDR. RICHART,The Sir Mortimer B. Davis Jewish General Hospital Montreal, Quebec, Canada, and Columbia Presbyterian Medical Center, New York, New York, 10032. CO, laser energy is absorbed by intracellular water but not by proteins or nucleic acids. The possibility of dispersing viral DNA during laser therapy of HPV-containing genital infections has been explored using the dot blot hybridization technique (Virapap/Viratype, LTI, Gaithersburg, MD). Samples were taken using dacron swabs from 1IO patients in nine separate treatment sessions as well as from five filters, four fume evacuator tubes (Biovac), and the nasopharynx, eyelids, and ears of the laser surgeon before and after laser surgery. The viral RNA probes were specific for groups of HPV types 6/l 1, 16/18, and 31/33/35. HPV DNA was identified in swabs fom 65/l 10 (60%) of lesional tissues. One of the five filters tested in 37 (2.7%) HPV DNA positive lesions contained HPV DNA type 6. The four fume evacuator tubes tested from 28 HPV DNA positive lesions were HPV DNA negative as were the nasopharynx, eyelids, and ears of the operator. Although HPV DNA may be released during laser therapy for genital HPV infections, providing appropriate equipment for evacuating HPV DNA positive smoke is used, contamination of the operator is unlikely. 13. Cisplatin and Adriamycin Combination Chemotherapy for Uterine Stromal Sarcoma and Mixed Mesodermal Tumors. W. A. PETERS
III, S. E. RIVKIN, M. R. SMITH, AND D. W. TESH, Puget Sound Oncology Consortium, Seattle, Washington 98104. Twenty-six patients with a uterine stromal sarcoma or mixed mesodermal tumor were treated with cisplatin 100mg/m’ and Adriamycin 45-60 mg/m*, given iv every 3 to 4 weeks with iv hydration. Group I consists of 10 patients with measurable disease following initial surgery or with a recurrence. Seven of the 10 patients with measurable disease had a complete response (70%) and 2 of these patients have had a negative second-look procedure and are alive and disease-free more than 24 months after initiation of treatment. Group II consists of 16 patients treated with adjuvant chemotherapy after primary surgery. The patients were selected for adjuvant therapy based upon previously established poor prognostic features. Of the 16 patients in Group II, 13 had invasion of the outer one-third of the myometrium and the other 3 had invasion to the middle one-third. Seven had documented positive pelvic and/or periaortic lymph nodes and 4 had positive peritoneal washings. With a median follow-up of 30 months, there have been only 4 recurrences in Group II. Two of the recurrences occurred in patients who discontinued therapy after only two cycles of chemotherapy. There is a projected 5-year survival of 72% in these high-risk patients. Of the 7 patients with documented nodal involvement, 1 patient died with a recurrence at 23 months and the other 6 are alive and disease-free